Newborns chloramphenicol toxicity

The activity of glucuronidation is low in the newborn, especially in premature babies (6). This is evident in the jaundice observed in many newborns because the major clearance pathway for bilirubin is glucuronidation. This can also lead to increased toxicity of some drugs in the newborn such as the grey baby syndrome seen in newborns treated with chloramphenicol. 

Weiss, C.E, Glazko, A.J., and Weston, J.K. (1960) Chloramphenicol in the newborn infant a physiologic explanation of its toxicity when given in excessive dose. N Engl / Med 262 787-794. 

Age Renal or hepatic elimination processes are often poorly developed in newborns, making neonates particularly vulnerable to the toxic effects of chloramphenicol (see p. 320) and sulfonamides (see p. 289). Young children should not be treated with tetracyclines (see p. 311) which affect bone growth, or fluoroquinolones (see p. 323), which interfere with cartilage growth. 

Studies of chloramphenicol pharmacokinetics were subsequently performed in newborns and children. High concentrations of chloramphenicol and its metabolites accumulated in newborns who developed toxicity (Figure 23.1 A)/ and presumably accounted for the severe toxicity. This accumulation of drug on a... 

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